Hemorrhoidectomy Instruments: Complete Anorectal Surgery Guide

Two operations dominate excisional haemorrhoid surgery, and the instrument tray tells you which one you are walking into before the surgeon says a word.

The anorectal set is small compared with a laparotomy tray, but every instrument on it is chosen for one hostile environment: a tight, moist, well-innervated canal where exposure is everything and bleeding is constant. This guide covers the complete set of hemorrhoidectomy instruments for open and closed procedures, plus the stapled and Doppler-guided variants that need dedicated devices.

Diagnosis and Grading Before the Excision

Before a single cushion is excised, the surgeon confirms the grade and position of the disease. That examination has its own short instrument list, and it usually shares the tray.

• Anoscope (proctoscope) — a short tubular scope that presents the anal canal and distal rectum, used to confirm the number and position of the haemorrhoidal columns, classically at 3, 7 and 11 o’clock in the lithotomy position.
• Sigmoidoscope — to exclude a more proximal source of bleeding before attributing it to haemorrhoids.
• Lubricated examining finger and swabs — for the digital rectal examination that precedes any instrumentation.

Skipping this step is a classic error: rectal bleeding blamed on haemorrhoids can mask a proximal tumour, which is why the scope goes in first.

Exposure: The Anal Retractor Decides the Case

You cannot excise a haemorrhoidal cushion you cannot see, and the anal canal collapses the instant you stop holding it open. Retraction is the first and most important choice on the tray.

• Parks self-retaining retractor — a bivalve or trivalve retractor that holds the canal open without an assistant, freeing both of the surgeon’s hands. The workhorse for excisional haemorrhoidectomy.
• Hill-Ferguson retractor — a curved, single-blade retractor that presents one haemorrhoidal column at a time while protecting the sphincter. Available in small, medium and large to match the canal.
• Fansler and Sims speculums — tubular and vaginal-pattern retractors used for circumferential exposure in some anorectal work.
• Eisenhammer bivalve retractor — adjustable blades that spread the canal for wider access.

A self-retaining anal retractor works on the same self-holding principle as the Gelpi retractor used in perineal and orthopaedic surgery — the blades lock apart so the field stays open through the whole excision.

Grasping and Clamping

Each haemorrhoidal cushion is grasped, drawn down, and clamped at its base before excision. Precise, secure clamping at the pedicle is what keeps the field dry.

• Kocher (Ochsner) forceps — the toothed tip grips the perianal skin tag or the apex of the cushion firmly for traction.
• Allis tissue forceps — atraumatic grasping of the mucosa and cushion during dissection.
• Curved artery (haemostatic) forceps — a Halsted mosquito or a Crile placed across the vascular pedicle before it is transfixed.
• St Mark’s pattern forceps — dedicated anorectal haemostats used in some UK sets.

Cutting and Dissection

Excision can be sharp, by diathermy, or by an energy device. The tray usually carries all three options.

• Mayo and Metzenbaum scissors — curved Mayo for the tougher perianal skin, Metzenbaum for the finer submucosal dissection that spares the internal sphincter.
• No. 15 scalpel on a No. 3 handle — for the initial skin incision at the base of the external component.
• Monopolar diathermy pencil — increasingly the primary cutting and coagulating tool, reducing intraoperative blood loss.
• Advanced energy devices — LigaSure and Harmonic haemorrhoidectomy seal the pedicle and divide it in one step, a technique associated with less postoperative pain in several trials.

Suturing and Ligation

In the closed Ferguson technique the mucosal wound is sutured; in both techniques the pedicle is transfixed. Rubber band ligation, often combined with excision, needs its own applicator.

• Needle holder — a fine Mayo-Hegar or Crile-Wood for placing 3-0 chromic or polyglactin on the pedicle and mucosal closure.
• Barron or McGivney band ligator — for banding internal haemorrhoids, frequently used alongside excision of the external component.
• Suture scissors and fine tissue forceps — toothed and non-toothed Adson pattern for handling delicate anoderm.

The precise mucosal handling here calls for the same delicate, fine-tipped pickups described in our guide to Adson forceps.

Stapled and Doppler-Guided Variants

Two device-driven procedures sit alongside conventional excision and need purpose-built kit rather than a general set:

• Stapled haemorrhoidopexy (PPH / Longo procedure) — uses a circular stapling device with a purse-string anoscope and threader to resect and lift a ring of rectal mucosa above the dentate line, treating prolapse rather than excising cushions.
• Doppler-guided haemorrhoidal artery ligation (HAL/THD) — uses a specialised proctoscope with an integrated Doppler probe to locate and suture-ligate the feeding arteries.

Both are single-use or device-specific and are not part of a reusable steel tray, but a hospital offering the full range of haemorrhoid surgery keeps them stocked alongside the conventional set.

A Complete Excisional Set at a Glance

The distinction that separates one set of hemorrhoidectomy instruments from another is rarely the forceps or scissors — those are shared across general surgery. It is the anal retractor and the energy device that define the case.

Materials and Reprocessing

Reusable anorectal instruments are manufactured from surgical stainless steel — martensitic AISI 410/420 for scissors and clamps, austenitic grades for retractors that need corrosion resistance through frequent cycling. Because anorectal cases are contaminated by definition, point-of-use enzymatic soaking and thorough ultrasonic cleaning are non-negotiable before sterilisation. Retractor blades and box-lock joints trap faecal and blood soil, so instruments are cleaned open, inspected, and steam-sterilised as a wrapped tray. Fizza Surgical manufactures anorectal retractors, forceps and scissors under ISO 13485 with full CE marking.

Sourcing an Anorectal Surgery Set

A well-built haemorrhoidectomy tray comes down to graded anal retractors that hold exposure, secure grasping forceps, and clean-cutting scissors that spare the sphincter. Fizza Surgical supplies the complete proctology and anorectal instrument range — for related diagnostic tools, see our comparison of the anoscope, proctoscope and sigmoidoscope, or browse the full surgical instruments catalogue.